OncoBriefs: H&N Cancer, Melanoma, Disparities

Bad lifestyle habits that contributed to head and neck cancer continued after diagnosis in patients with human papillomavirus (HPV)-negative oropharyngeal cancer, a retrospective chart review showed.

Heavy alcohol consumption and use of marijuana occurred significantly more often among patients who had oropharyngeal carcinoma unrelated to HPV infection. Patients with HPV-negative disease also had higher rates of chronic obstructive pulmonary disease (COPD) and anxiety, and missed significantly more days of scheduled radiotherapy.

Significantly more HPV-positive patients reported having never smoked, Allen M. Chen, MD, of the University of California Davis in Sacramento, and co-authors wrote online in JAMA Otolaryngology -- Head & Neck Surgery.

HPV-positive oropharyngeal cancer confers a more favorable prognosis as compared with HPV-negative disease. The extent to which pre-existing conditions contribute to the disparity had not been examined previously.

Chen and colleagues analyzed data for 162 consecutive patients with locally advanced squamous-cell carcinoma of the oropharynx treated with primary chemoradiation therapy or by surgery followed by adjuvant radiation therapy. Investigators used immunostaining techniques to determine the HPV status of each patient.

"Patients with HPV-negative oropharyngeal cancer ... carry a much higher burden of competing risk factors for death, likely as a result of presenting at an older age and with more extensive histories of tobacco, alcohol, and/or marijuana use," the authors concluded.

"This population is also more likely to experience delays and interruptions in prescribed radiation therapy. Treatment adherence, in addition to competing mortality risk, needs to be considered in outcome reporting and the design of clinical trials addressing these populations in the future."

IBD-Melanoma Link?

Patients with inflammatory bowel disease (IBD) had a significantly increased risk of melanoma, according to a systematic review and meta-analysis.

Examination of data from 12 studies involving 172,837 patients with IBD identified 179 cases of melanoma, translating into an incidence of 27.5 cases per 100,000 person-years, Edward V. Loftus, MD, of the Mayo Clinic in Rochester, Minn., and co-authors reported in the February issue of Clinical Gastroenterology and Hepatology.

Comparison of melanoma rates in the IBD patients and general population produced a relative risk of 1.37 for melanoma in association with IBD (95% CI 1.10-1.70). The melanoma risk was increased in patients with Crohn's disease (RR 1.80, 95% CI 1.17-2.75) and ulcerative colitis (RR 1.23, 95% CI 1.01-1.50).

The authors found that the increased risk of melanoma was limited to studies conducted before 1998, when biologic therapies were introduced. IBD patients had a melanoma risk of 1.52 in eight early studies (95% CI 1.02-2.25) versus RR 1.08 for studies conducted after 1998 (95% CI 0.59-1.96).

By multivariate analysis, IBD remained significantly associated with melanoma, independent of treatment with immunomodulators and inhibitors of tumor necrosis factor-alpha (TNF-α).

Noting that IBD previously has been linked to an increased risk of nonmelanoma skin cancer, the authors concluded that their study "strengthens the recommendation for routine screening for cutaneous malignancies in patients with IBD. Furthermore, primary prevention through sun-protective measures should be advised to all patients with IBD, regardless of thiopurine and/or ant-TNF-α use."

The authors of an accompanying editorial cautioned against jumping to action on the basis of the findings.

"There are sufficient data and biologic plausibility to suggest an increased skin cancer risk in IBD patients," said Derrick Siao, MD, and Fernando Velayos, MD, of the University of California San Francisco. "There is insufficient information, however, to tell clinicians how to use the data clinically.

"There are no IBD-specific recommendations that are actionable regarding if and how skin cancer counseling and screening should occur, who should be screened, and whether or not it should differ in IBD patients compared with the general population."

Siao and Velayos encouraged continued evaluation of data to see whether concern is justified and then, and only then, develop "explicit, actionable, and evidence-based recommendations" with input from the dermatology community.

Cancer Groups Tackle Disparities

Some of the nation's leading cancer organizations have announced plans for collaborative research aimed at reducing cancer health disparities.

Comprehensive research is needed to understand the causes of disparities in cancer outcomes and access to care and to develop strategies to correct the disparities, leaders of the American Cancer Society (ACS), National Cancer Institute, American Society of Clinical Oncology (ASCO), and American Association for Cancer Research (AACR) said in a statement.

"Closing the inequality gap will not happen easily and won't get done if any of us goes it alone," said Otis W. Brawley, MD, chief medical officer of the ACS. "It will require a serious commitment, and we're proud to join our colleagues to work together to make sure all Americans benefit from the lifesaving progress against cancer."

The organizations convened a meeting of authorities in clinical research, epidemiology, public health, and healthcare policy, as well as patient advocates, to review the state of science, discuss needs and priorities in cancer disparities, and reach a consensus on recommendations. The recommendations will form the basis for a forthcoming statement that will outline research needs and priorities.

The joint effort will target some of the most prevalent disparities in cancer care, including the higher rates of cancer, reduced access to quality care, and increased mortality among ethnic minorities as compared with whites. Currently, African-American men have a 33% higher cancer mortality than do white men, and a 16% disparity exists between African-American and white women.

Recognized disparities among older patients and among socioeconomically disadvantaged individuals also will receive attention.

"We must move from describing the problems to more quickly identifying and implementing solutions to address the racial and economic-based disparities that continue to affect many cancer patients and their families in the United States," said ASCO president Clifford Hudis, MD, of Memorial Sloan-Kettering Cancer Center in New York City.

Both ASCO and the AACR previously initiated annual conferences on disparities in cancer care and outcomes.

More Evidence of Disparities in Cancer

Improvements in colorectal cancer survival have occurred primarily among non-Hispanic whites, Asians, and the under-65 population, according to a study by the American Cancer Society.

From the period of 1992 to 1997 to the period of 2004 to 2009, 5-year survival in colorectal cancer increased from 9.8% to 15.7% among non-Hispanic whites and 11.4% to 17.7% for Asians, both of which were statistically significant. In contrast, little change occurred in 5-year survival among non-Hispanic blacks (8.6% to 9.8%) and Hispanics (14.0% to 16.4%).

Survival among non-Hispanic whites 65 and older improved significantly, but to a lesser degree as compared with individuals 20 to 64, researchers reported online in Cancer Causes and Control.

"We know from previous studies that when people of any race get equal care, they have similar outcomes," Helmneh Sineshaw, MD, head of the ACS research group, said in a statement. "The reasons why ethnic minorities are not getting equal treatment are complicated, but likely include poorer health coming into the system and lower socioeconomic status, which clearly leads to barriers to good healthcare."

The findings were based on an analysis of data for 50,000 patients with colorectal cancer identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.

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